Nova Scotia auditor general Michael Pickup fields questions at a news conference in Halifax on April 3. A new report by Nova Scotia’s auditor general slams the lack of oversight and financial management by the board of the IWK Health Centre in Halifax. Michael Pickup says he was shocked to see the ‘extent and severity of weakness in basic financial management controls at the IWK.’ - The Canadian Press

Another auditor general’s report, another warning to Nova Scotians that their health-care system suffers under poor leadership and a lack of direction.

From turf battles and confusion over roles among the various bureaucracies, to the absence of financial controls at the IWK, Michael Pickup’s latest report looks inside the fragmented provincial health system and what it finds isn’t pretty.

“The Department of Health and Wellness (DHW) has failed Nova Scotians on this front,” Pickup said, referring to overall management of the technology that underpins virtually every part of the health system in Nova Scotia.

The auditor general’s December report also drilled down into a litany of lax or non-existent financial controls at the IWK Health Centre, where the only solace is found in assurances from the current management and board of directors that improvements are under way.

Pickup noted failures at the IWK are financial and in no way reflect on the high quality of care being provided at the hospital for women and children.

Earlier this year, former IWK CEO Tracy Kitch and the hospital’s former chief financial officer Stephen D’Arcy were charged with fraud and breach of trust dating to their time at the IWK.

Pickup said financial irregularities and abuses are much more common in organizations with poor financial controls, and he’s never seen an organization like the IWK, which was unable to produce 80 per cent of documents related to purchasing that Pickup’s office requested.

“Although the IWK Health Centre Board has many good governance practices, based on the pervasive financial internal control weaknesses, the Board did not effectively govern the IWK Health Centre,” Pickup concluded.

Just over a year ago, Pickup issued a report critical of the government’s handling of changes in health care and drew the ire of Premier Stephen McNeil, who suggested the auditor general had overstepped his bounds.

The current report is no less critical and concludes risks to the health system are not being adequately managed by the various government agencies charged to do the job.

“The Department of Health and Wellness has not provided the level of leadership and direction required to effectively transition the health sector to centralized information technology services,” Pickup writes.

Effective and efficient health care requires that information technology systems and personal health information remain secure and available, Pickup wrote, adding that failure to do so can have significant consequences, including unauthorized disclosure of personal health information, increased wait times for services, increased costs to the health-care system, and overall negative impacts on the health and well-being of Nova Scotians.

The health IT systems, as the auditor found them, risk all of those negative consequences, in part because the roles for each of the players have not been clarified or formally agreed upon. The players are the DHW, the Nova Scotia Health Authority, the IWK and the Department of Internal Services, which provides centralized government IT services.

Pickup discovered three draft agreements between Internal Services and the health bureaucracies for the delivery of central IT services, but due to questions surrounding roles and accountabilities those contracts remained unsigned.

In addition, the DHW and the NSHA are feuding over control of several essential IT applications that the department claims support provincial health programs, but the authority maintains are clinical and should be within its mandate.

“This is an example of the issues that occur when leadership and direction are not effective in resolving key issues. A decision which was considered at length remains an ongoing issue, more than three years after the creation of the Health Authority,” Pickup notes.

Tension between DHW and the NSHA has been an open secret for years, but the auditor general’s report is the first to identify the dysfunctional relationship and its negative consequences.

The various bureaucracies need to get their collective act together before they try to implement the One Person One Record information system or, as Pickup said, Nova Scotia may be stuck with another Phoenix fiasco.

Phoenix is the federal government’s flawed payroll system that hasn’t worked properly since its inception several years ago, leaving federal public servants perpetually uncertain about whether their pay is correct, if they get paid at all.

Done right, One Person One Record has the capacity to significantly improve the delivery of health care. Done poorly it could cripple the health system.

Based on the findings of the auditor general, the McNeil government needs to sort out its various health bureaucracies before it tries anything as costly and complex as OPOR, because the current state of confusion would seem to guarantee failure.